The Joint Committee on Finance (JFC) approved a motion yesterday that will have significant ramifications for health care accessibility and affordability in Wisconsin.Many of these decisions were on issues that have been covered at length by this site, including proposed changes to BadgerCare for Childless Adults, full Medicaid expansion under the Affordable Care Act, and proposed changes to the SeniorCare prescription drug program.For a more complete rundown on the committee’s actions, see below.Changes to BadgerCare for Childless Adults The committee largely approved the Governor’s proposed changes to BadgerCare for childless adults along a party-line vote.The Governor’s proposal would allow the Wisconsin Department of Health Services (DHS) to request approval from the federal government to make the following changes for any childless adult on the program:

Require childless adults at or below the poverty line to pay monthly premiums as determined by DHS

Require all such enrollees be subject to a health risk assessment

Impose even higher premiums on enrollees who engage in behaviors that increase their health risks, as determined by the health risk assessment.

Limit lifetime eligibility to no more than 48 months.

Require all childless adults on the program to take a drug screening assessment and, if indicated, a drug test.

The committee already largely approved the drug screening provision earlier in the week.The only changes made by the committee was to require DHS to submit a report the JFC detailing the provisions contained in the waiver that will be submitted to the federal government and an estimate of the fiscal effect of the proposed changes.If the federal government approves the waiver request, DHS will then be required to submit another report to the JFC describing the provisions of the approved waiver and its estimated fiscal effect before DHS can implement the new changes.For more information about significant concerns raised by advocates for health care accessibility about the Governor’s proposed BadgerCare changes, please see our BadgerCare issue page.Rejection of Federal Medicaid ExpansionThe committee also voted along party lines to reject a motion by the committee’s Democrats to accept federal funding to expand BadgerCare eligibility to childless adults earning between 100-138% of the federal poverty line (FPL).Updated projections from the Legislative Fiscal Bureau estimated that the amount of money the state could save if Wisconsin implemented full Medicaid expansion increased from previous estimates.The LFB previously estimated that accepting full Medicaid expansion would save the state $345 million.The new estimates increased the projected savings to $365 million.As a result of the committee’s decision, tens of thousands of Wisconsinites will still find themselves in a health care coverage gap and the state will have to make hundreds of millions of dollars of budget cuts to other vital public institutions, such as the cuts proposed by the Governor to the University of Wisconsin System.Reject the Governor’s Proposed Changes to the SeniorCare Prescription Drug ProgramThe JFC did fully reject the Governor’s proposedchanges to the SeniorCare prescription drug program, which would have required eligible seniors to first sign up for the more expensive Medicare Part D prescription drug program.The LFB estimated that many low-income seniors who fall into a relatively likely scenario would pay about $188 a year more for their prescription drugs if the Governor’s proposed changes were approved.The committee’s unanimous rejection of the Governor’s SeniorCare proposals is likely good news for the thousands of women who rely on the program.For more information about how the Governor’s proposal would have affected women in Wisconsin, please see our SeniorCare issue page and our blog post on the topic.Other Budget Health Care UpdatesThe JFC made many other important decisions regarding health care policy.We will provide more information regarding these changes in subsequent posts.

The Joint Committee on Finance (JFC) voted 12-4 on partisan lines yesterday to approve a motion that will allow the Wisconsin Department of Health Services (DHS) to apply for a waiver with the federal government that would allow Wisconsin to screen childless adults on BadgerCare for substance abuse as a condition of BadgerCare eligibility.

In addition to approving the Governor's recommendation to seek a waiver from the federal government to allow DHS to drug screen childless adults on BaderCare, the JFC also required the Department to (1) provide the committee with a summary of the provisions of the proposed waiver and estimates of the fiscal effect of that proposed waiver, and (2) if the federal government approves the waiver to permit drug testing, and prior to implementing that policy, to submit a report to the JFC that summarizes the provisions and estimates the fiscal effect of the approved waiver.

We have covered the issue of drug testing participants in public benefit programs at length on our budget site. Many advocates express skepticism that this approach will actually provide people with substance abuse disorders with the help that they need to treat their addictions. Rather, advocates fear that this approach will unnecessarily stigmatize lower-income people who need BadgerCare in order to access vital health care services. For instance, advocates for people with disabilities have expressed significant concerns about the affect this proposal could have on childless adults who rely on BadgerCare and have simultaneous mental illness and substance abuse disorder diagnoses. Federal courts have also ruled that similar proposals to drug test public benefit recipients in other states are unconstitutional.

The full Department of Health Services budget is up for debate and executive action in the JFC tomorrow, including votes about the Governor's other proposed changes to BadgerCare coverage for childless adults, so we will have many more updates soon to follow.

In response to Governor Walker’s proposed state budget, the Wisconsin Budget Projecthas released an alternative budget that avoids the worst of the Governor’s proposed budget cuts to education and vital health care programs by capping ineffective tax breaks and accepting federal Medicaid expansion funding. More than two dozen organizations and advocacy groups have signed on to support this alternative budget.The Better Choices alternative budget proposes freeing up revenue by extending BadgerCare benefits to adults at 138% of the Federal Poverty Line in order to accept federal money for Medicaid expansion. The Legislative Fiscal Bureau estimates that this would free up $345 million in the budget and cover 81,000 more adults under BadgerCare. According to the Kaiser Family Foundation’s recent report, Medicaid is an essential program to protect the health and well-being of low-income Americans who otherwise would not have insurance. Additionally, the alternative budget reallocates funding for the Governor’s proposed $211 million property tax cut and caps the expanding costs of a tax break created in the 2011-2013 budget bill. These three measures would free up $782 million of revenue in the budget to invest in important programs that support the health of our communities.Under the Better Choices alternative budget, the $782 million would mainly be reallocated to cover the proposed $300 million cut to the UW System, to give $200 million more to K-12 education than currently proposed in the Governor’s budget, and to cover the proposed cuts to long-term care for seniors and people with disabilities. The alternative budget proposal would also bolster revenue by $50 million, undo cuts to the Homestead Tax Credit and the Earned Income Tax Credit, and avoid $162 million of other damaging budget cuts (See Graph). The Wisconsin Budget Project believes that this alternative budget would better invest in Wisconsin’s future and respond more appropriately to Wisconsin’s needs. For more information about the alternative budget visit Better Choices for Wisconsin. The WAWH Budget Project will continue to update our issue areas and blog posts as the JFC debates and votes on the Governor’s budget.

Leaders on the Joint Committee on Finance (JFC) made an important announcement today that the committee will reject many of the Governor's proposed changes to vital long-term care programs such as Family Care, IRIS (Include, Respect, I Self-Direct), and Aging and Disability Resource Centers (ADRC's), which provide assistance to the elderly and individuals with either developmental or physical disabilities at their homes rather than at long-term care facilities.

The Governor’s proposed budget would have expand the Family Care program to all 72 counties in the state.

However, the proposed budget would also have made sweeping changes to the delivery of the Family Care program and eliminated the IRIS program . Advocates for people with disabilities and older adults raised significant concerns that the proposed expansion program will be a pared down version of the current Family Care program. Under the proposed budget, administration of Family Care would have been restructured from a regionalized, not-for-profit system to a statewide system open to for-profit insurers. In addition, current IRIS participants would not have had the same authority and flexibility to self-direct their care under the newly proposed Family Care model.

The JFC leaders' announcement outlines how the committee will amend the Governor's proposal. Rather than a dramatic overhaul of the entire long-term care system, the committee will likely approve a more modest approach that guarantees input from all relevant stakeholders. One of the main criticisms from advocates about the Governor's proposal was that key stakeholders were not consulted about the dramatic changes proposed by the Governor. The JFC will also require that ADRC services be preserved and that the JFC must give the Wisconsin Department of Health Services (DHS) approval of any waiver plan that DHS hopes to submit to the federal government for approval.

This proposal represents a significant change to the Governor's proposed budget. For more background information on this issue, please see our issue section on Family Care and our previous blog posts on the the issue.

After the Legislative Fiscal Bureau (LFB) announced Wednesday that there would not be an increase in projected state tax revenue, Assembly SpeakerRobin Vos, Senate Majority Leader Scott Fitzgerald, and JFC Co-Chair John Nygren said that their top priorityin the ongoing budget deliberations will be to fully fund K-12 education. Although Governor Walker’s budget proposed a $127 million cut to K-12 education during the first year of the biennium, the Governor expressed his support this week to fully fund K-12 schools and to make “our schools whole.” Democratic legislators have also identified public K-12 education funding as a priority, along with reducing proposed cuts to the University of Wisconsin system and rejecting significant proposed changes to long-term care programs.No specific revenue source has been agreed upon to increase K-12 funding, but lawmakers from both sides of the aisle have proposed a variety of options. Vos, Fitzgerald, and Nygren suggested using money the governor had set aside for the school levy credit to instead fully fund K-12 education. Fitzgerald said Republicans would be interested in plans that would increase revenue and lower bonding. The four Democratic members of the Joint Finance Committee (JFC) have suggested other methods of funding K-12 education, such as delaying the phase in of manufacturing and agriculture credits, forgoing property tax cuts, and accepting federal Medicaid expansion money. Republican members of the JFC warn that these ideas would meet resistance in the GOP caucus. Although the funding source remains unclear, it is clear that Wisconsin lawmakers are making increased funding for K-12 education a priority in the 2015-2017 state budget. The WAWH budget blog will continue to provide more details on the K-12 budget as the JFC votes on these provisions. For more information on Governor Walker’s proposed public education budget and its impact on Wisconsin women and girls, visit our issue page on K-12 education here.

The co-chairs of the Joint Committee on Finance (JFC)--Rep. John Nygren and Sen. Alberta Darling--announced today that the Legsiature would not support Governor Walker's budget proposal to convert the University of Wisconsin System into a public authority model. The Governor's proposal caused controversy both within the UW System and with many legislators.

The co-chairs also indicated that the JFC hoped to reduce the Governor's proposed $300 million dollar funding cut for the UW System. However, they indicated that the size of the reduction would depend on how much revenue will be available based upon the new revenue estimates that are due out likely at the end of this week or early next week.

The Wisconsin Alliance for Women's Health budget blog will provide more details on the UW System budget when the JFC decides to take up these provisions. In the meantime, readers who are interested in this issue and how it impacts Wisconsin's women and girls can check out our issue page on the UW-System ﻿here﻿.

On April 3rd, Rep. Mark Born (R- Beaver Dam) made a budget motion request to the Joint Finance Committee (JFC) to remove provisions from the state budget that would eliminate the IRIS program and significantly change the FamilyCare program and Wisconsin’s Aging and Disability Resource Centers (ADRC’s). For more information on the budget’s proposed changes to these important programs, check out our blog post and the FamilyCare issue area on this site. The changes to FamilyCare, IRIS, and the ADRCs in Governor Walker’s budget are concerning both because they will affect thousands of Wisconsinites and because they were included in the budget proposal without knowledge or inputfrom disability rights advocates, legislators, current program coordinators, or people currently served by the programs. Rep. Born’s concerns echoed those of his constituents and residents across the state who depend on these current long-term care programs to provide quality and cost-effective care for their families. Furthermore, the budget does not propose a clear plan or funding source for the proposed changes to Family Care and ADRCs. Advocates for people with disabilities and seniors claim the proposed changes need further research by DHS and stakeholders before they go into effect and change the established long-term care plans of Wisconsinites. Rep. Born’s proposal is supported by multiple disability rights advocacy groups, including Disability Rights Wisconsin, the Survival Coalition of Wisconsin Disability Organizations, and the Wisconsin Board for People with Developmental Disabilities.

At this time, it is unclear whether the JFC will pass Rep. Born’s motion, pass more modest changes to the Governor’s long-term care proposals, or adopt the Governor’s proposals in whole. Please stay tuned to our blog for more updates as the Joint Finance Committee continues to debate and vote on the Governor’s proposed budget.